Wednesday, September 2, 2015

It's All About the Detective Work

When I think of the right way to triage, I think about how to be a good detective. Triage is about sorting through the details to get to the root of the problem, and isn't that what detective work is too?

With triage, you should have protocols or algorithms to follow that are symptom based. If you do not have these in place, then you probably do not have a safe triage program. However, so many nurses get so caught up in sticking closely to these guidelines that they do not allow themselves do think outside the box.

Let me give you an example. A mom calls about a child with a low temperature. The child's temp is 97.1R. In the conversation, the mom tells the nurse that the child was outside earlier in the day, in freezing temps, without proper winter clothing. After which, she came in, bathed and then started to appear as if she was really not feeling well. At that point, the mom decided to take her temperature. The child is now in bed, very fatigued, and barely responsive to mom. The nurse, hearing this, automatically starts thinking frostbite, and goes straight to that protocol. She shuts down the possibility of any other symptoms and fails to ask. She gives mom homecare advice to warm the child, and told mom to call back if symptoms do not improve. The mom follows the nurse's advice, and by morning, the child was rushed to the ED with symptoms of sepsis. If the nurse had opened her mind to other possibilities and asked if the child was recently treated for any illness or injury, or asked if she had any other symptoms present; she would have discovered that the child had just finished a course of antibiotics for a wound infection. The wound was not appearing better, and the mom intended to call the physician's office the next morning to report it.

We can never assume callers are telling us the whole story. It is our duty to ask for it. Many times, the caller assumes that certain information is not relevant and do not think that we need to know. Solving the mystery means asking for the details, sorting through them, following the appropriate guidelines, and coming up with a solution that is safe, agreeable by all, and is in the best interest of the patient.